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05/30/2017 09:32 #2213 P. 001/001 <br /> �ECTRIGAL PERMIT A,P�ICATION <br /> CITY OF�V�R�TT P�RMIT SERVICES <br /> 3200 CEDAF2 STREET,�VERETT,WA 98209 <br /> (P)425-257-8810 � FAX 425-�257-8857 � (�)�verettepsQ�vere�twa_gov� www.everetlwa.govlpermits <br /> . . . pRO.l�CT:S�T�:�INFOR�IATlC1N. • � � <br /> P�tOJ�CT ADDRESS: � O 1_ <br /> BUILDING ARF1►(if resitleritiat,new construotio�,rernodel,or eddition) SF <br /> BLIIL�ING TYP�: C7 SFR-D�7ACH�0 ❑SFR-ATTACH�D ❑DUPL�X ❑MULT(-FAMI�Y-#OF LINITS:�„� C1 CQMMERCIAL <br /> US�OF HUI�DING: <br /> . ��CT CAL;��ARPf.ICATiOw'.INFORMATtON•�� � � � <br /> GONTRACT PRIC�OF WORK: /� D CJ U <br /> NVM��R OF DEVIC�S if!ow v Ita e : <br /> FIR�A�ARM? Cl Y�S 0 <br /> ASSOC[ATED �UIL,DING PERMI7 � licable : <br /> QES�RIPTiON�F WOR • D . / E � L/ � �D �^ � <br /> � . .CONTACT INFO#tIViAT10N. . . <br /> pWNER NAME: YENANT NAME If Cammercial: <br /> OWN�R MAIU�3G AD[1RESS: s'��r L. <br /> Cm' STAlE 21P /�/ <br /> oWNER PHONE: � JrA Z. QWNER EMAIL: ' <br /> COfdTRACTOR ldAM�: � � <br /> CONTRACTOR ADDRE55: srRe�r <br /> C11Y a'TA7k ZIP <br /> CONTRACTOR P3iONE: � CONTRACTOlZ EMA1L: ' <br /> CON7EtACYOR UC,#{REQUIR�p: C1TY OF EVEREiT BUSINE3S I�IC.#{Fi�QU{REP): l ,� <br /> PRIMARY CON7ACT: D OWNER ❑CON7RAC'FOR C3 OTHER(Please Spec.Ify) <br /> CONTACT NAME: ��� �L-� CQNTACT PiiON�: � �� ?,� <br /> �� d��t, coNracT eMa�,: <br /> A�SR��AlENT•f horebY ce�t11Y that 1 hava read and examin@d thla aPAkcaticn and knaw the sarrre Eo be hue end cor�ct A!I proNs�ons of laws and wdkrences ga�rg lhla b�p� <br /> vf worK w111 Da cor►�uated wAether apecHJee RereM or rtot The grenung ot a p�mtit doea not presrunm to Li1ve�irllw,�ry to vlo�te or eanoel the pravtsla+s a�eny vOhsr state w <br /> (ocal lew reQuleflnv c�onstruc6on vr tha performarxa�af cnnattiGtfw+. Trist 1 am quthorized by the ownar of thls D+nAB/tY to Pe�lom9 the wo�l�!or wlilch appNtatlon ds mRde 8n4! <br /> comply wdth tha Sfate Lbn¢actala La+y 18.27 RCW�d 28�,200 WAG. <br /> Cky oI E�rerett OfRclal Usa Only <br /> �e�Mir# <br /> sa' E l�S — 1,g ( <br /> O Bori�tl Apen!Sfgnaturo a te (RevJsed&i22s,,?p76) <br />